Our Community Health Improvement Plan:

SCPHN 2nd Annual Report to the Community

People make lots of resolutions at the start of the New Year. We have heard them all: go to the gym every day; lose weight; improve our eating habits or drink less alcohol.They are all excellent goals but are very broad and can set up an individual to feel worse than better if they fall short. Focusing on physical well-being is very common. Emotional health is just as important.Working towards achieving balance in physical and emotional health is an excellent target for 2019. Take the time to stop ask yourself if you are too hard on yourself, rush through the moments in your life, miss time with family and friends or hibernate with singular focus on tasks and responsibilities.

Below are some ways to think about helping yourself feel more relaxed, supported and happy in your daily life.Just like any other resolution, these activities require some commitment and focus.See if you can picture yourself making some small changes to positively impact your life.

LET GO OF PERFECTION: Setting a goal of being perfect can lead to acute disappointment.Mistakes are normal.Forgiving oneself for falling short of your own, other’s or society’s expectations is hard but very important to avoid a toxic level of perfectionism that can lead to emotional issues like anxiety, depression, or more serious things.Don’t be afraid to ask for help if you recognize this trait in yourself.https://www.medicalnewstoday.com/articles/323323.php

BE MORE PRESENT: If you spend every day thinking about what you need to do or what you want for tomorrow and the future, you may miss a moment in the time you are in that makes you happy or helps you to feel content.Try to appreciate the place you are in and the people you are with.There is nothing wrong with setting goals and planning for the future, but if you focus solely on that you may miss a moment or encounter in the present that would make you smile and feel good.This is a part of learning to be mindful.Practicing mindfulness takes practice.Some people choose meditation, deep breathing, walking, yoga or a host of other calming activities to help them achieve it.https://www.psychologytoday.com/us/blog/when-your-adult-child-breaks-your-heart/201801/five-new-year-s-resolutions-improve-your-mental

SPEND TIME WITH FRIENDS AND FAMILY: Isolation can be very harmful to an individual.Certainly it is fine to want to spend time alone but being alone without regular contact with others can be damaging to your emotional heath and lead to depression, anxiety, low self-esteem and other issues. Spending time with family and friends can be very nourishing.Though potentially hard to initiate, making the effort to reconnect with friends and family can pay off in a very significant way.Greet your New Year and phone a friend. Here are some tips of navigating the process: https://www.psychologytoday.com/us/blog/the-man-cave/201808/5-proven-steps-reconnect-family-and-friends

BONUS TIP: Adopt a couple of small plants. Place them on your windowsill. Care for them and watch them grow. You will be surprised at the improvement in your mood when you find yourself caring for a living thing.You may have an awesome green thumb!

While making your resolutions for this New Year don’t forget your brain and your emotional health.Taking small steps to improve your mental health can help reduce your risk for many physical problems like heart disease and muscle soreness.

The stigma associated with accessing mental health and substance misuse services has been discussed in previous posts. Another stigmatized topic is the Mental Health Day. In our society and in particular, in the workplace mental health and physical health are not viewed in the same way. If someone is sick with the flu, we push them to stay home and rest so they can get better (and so they don’t spread germs). We know the event can be prolonged if the person returns to work while they are still ill. Why don’t we treat mental health the same way? When we acknowledge that Mental Health Days are valid, we will see improved attitudes in home and the workplace.Employers may experience improved productivity and decreased time out of work in the long term.

Because of that lack of focus,you’re beginning to feel more of a hindrance to those you meet than a help

You’re exhausted but you can’t sleep from the thoughts of dreading work the next day

You’ve noticed that it does not take much make you have feelings of anger or irritability

You feel like you’re in a haze or moving in slow motion

When one of your coworkers misses work it might be flu, back injury, a dental procedure or a general problem such as low grade fever, headache or stomach disturbance.Both of you are experiencing symptoms that will interfere with your ability to do your job, interact with others and be productive over the course of the day.The symptoms may last longer than one day.

Many employers require a note from a physician or clinic when an employee misses more than two days of work.This is actually a good policy.If someone is feeling so unwell that they have to miss more than two consecutive days of work it is not unreasonable to ask them to be seen by a professional. In some cases, that requirement is the way in which employees uncover an undiagnosed physical or mental condition that requires treatment.

How what should I approach my employer if I need a Mental Health Day?

It is unrealistic to predict when a person is going to feel overwhelmed or unwell.

Follow the established guidelines of your employer for notifying them of your need to be away from work.

If your work environment is positive and supportive, try to be as honest as possible with your employer.

Otherwise, just report that something urgent has come up and you will be out.

Some people with an ongoing need to have breaks, plan scheduled days of vacation off periodically to minimize other time out of work they might need.

It would be wonderful if all employers supported employee efforts to take care of their mental health. Workforce mental health is important not just to individuals, but to employers. The Center for Prevention and Health estimates mental illness and substance abuse issues cost employers as much as $105 billion annually. Reduced productivity, absenteeism, and increased health-care costs are just a few of the ways mental health issues cost employers money.

Taking a Mental Health Day periodically may help you to build mental strength and more agility when managing the stressors in your life.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 1 in 5 Americans will have some sort of behavioral or mental health disorder (MHD) at some point in their life. According to the National Institute of Health (NIH) 10% of Americans will have a substance misuse disorder (SUD) at some point in their life.

You may read that and think, “That’s not so many”. Consider this: Of the 20% of Americans who suffer with a mental health disorder, less than half will receive treatment.In addition, 76% of young people who suffer with depression receive no treatment for their condition.

Now is the time for change. Need for mental health and substance abuse treatment is increasing. Not all who need care are successfully accessing it.

A number of barriers exist to accessing care.

Lack of professionals in both mental health and substance abuse.

The cost of care – especially for those without adequate coverage.

Stigma – defined as,” a set of negative and often unfair beliefs that a society or group of people have about something.” An individual deeply perceives a feeling of stigma in the cases of substance abuse and mental health disorders and is less likely to try to find care.

Lack of Professional Development in Medicine– Even today many physicians, nurses and other health care professional are uncomfortable having a discussion with a patient about these issues.Professional development opportunities are lacking.

When Richard Nixon declared a “War on Drugs” in 1971, no one anticipated that it would be one of the longest running wars in history and continue today. In 1987, the Partnership for a Drug Free American launched its “This is your brain on drugs” campaign, illustrating the rapid frying of a cracked egg in a hot pan.

The brain does change when you use substances. The human brain is the most complex organ in your body. It controls all human activity and intellect. Drug use will affect the way your brain functions and your behavior in a significant way.

When you engage in an activity that you enjoy, your brain releases a hormone called Dopamine. Dopamine can be released while running, painting, doing art projects or eating a great cupcake. Even something as simple as drinking water can cause the reward system to be activated. It is how we survive. This is how pleasurable habits are formed. When we do something that causes dopamine to be released and we are rewarded with a good feeling, we go back to that activity to achieve that feeling again.

How does all of this play into addiction? Some pleasurable habits can be good; running every day is good for the cardiovascular system, muscular system, and skeletal system. Negative and dangerous habits form in the same way. Some examples of bad habits are overeating, misusing medication or other substances or drinking too much alcohol.

For some, it starts as experimentation. A person may try a particular substance for the first time. In this example, consider the substance to be an opioid. The first time a person tries an opioid, the brain lets it in because it causes more dopamine to be released and the pleasure sensors in the brain are stimulated. With such a strong pleasure reward, the brain will crave more and more. Over time, previously pleasurable activities like exercise or good food become less appealing as the brain becomes rewired to demand the pleasure provided through the opioid.

Harvard School of Public Health tells us that “Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences. (2011)

Your brain can recover. “Like other chronic diseases such as heart disease or asthma, treatment for drug addiction usually isn’t a cure. Nevertheless, addiction can be managed successfully. Treatment enables people to counteract addiction’s disruptive effects on their brain and behavior and regain control of their lives. (National Institueon Drug Abuse (NIDA, 2016)

There are many different types of treatment programs available. Treatment helps the individual detox from the opioid and manage the cravings. Many of them also teach coping skills and how to build strong social networks to help avoid relapse. As time goes on, the brain adapts to treatment, the urges are less prevalent, and the individual can begin again to enjoy other pleasurable activities in their lives.

Looking for more information on your brain and addiction? Check out these links:

This is the third and last in the “Treatment Defined” series. The purpose of this series has been to help readers understand what types of treatment are available, define them, offer resource information and simplify the language of treatment overall.

Previously we have described individual and group counseling as well as outpatient services. Lastly, we are going to talk about inpatient services. In this series segment, we are going to offer information on

Short term residential programs

Long term residential programs, and

Detox programs

Please remember that one size does not fit all when it comes to treatment options. The inpatient resources described below may be a perfect fit for some but other individuals may find success in an outpatient setting might do better with outpatient. Please consult your doctor or call the NH Helpline to talk a clinician at 844-711-4357 or 211.

Detoxification/Detox: Offered to assist an individual in the early stages of withdrawal from substance use, a detox program is a safe and monitored environment where trained health and social service professional can support individuals as they allow substances to filter out of their systems and manage the associated symptoms to minimize side effects.

Short-term residential programs: An intensive, structured setting using a modified 12-step program. For this type of program, individuals usually spend 3-6 weeks in a hospital like setting before they begin outpatient therapy or self-help groups. The outpatient therapy portion is an important part of this program as it helps reduce the risk of relapse and helps the individual form new social bonds.

Long-term residential programs: Offer care 24/7 in a non-hospital setting. Residence will vary between 6 and 12 months. These programs are generally very structured. Treatment in an environment of this type will rely on what is known as “social context” to help the individual identify ways to learn new, beneficial behaviors in a carefully while also learning to resist previous behaviors and unhealthy settings and relationships that might hinder recovery.

In this region, there are four (4) residential treatment options – three are located in Manchester. They are The Farnum Center, Cypress Center, and Westbridge Community Services (men only). In addition, Hampstead Hospital offers detox services in the region as well as other inpatient and outpatient services.

Please remember that one size does not fit all when it comes to treatment options. The inpatient resources below may be a perfect fit for some but other individuals may find success in an outpatient setting. Consider which option might meet your needs. Also, please consult your doctor or call the NH Helpline to talk a clinician at 844-711-4357 or 211 for additional information. .

For over 100 years, Old Home Day has been observed in towns across NH as a way to celebrate the community and reconnect with friends and neighbors. Many towns in the Granite State celebrate Old Home Day with parades, barbeques, games, and fireworks. These events are well organized, well attended, and enjoyed by the young, old, and everyone in between. Let us all safely celebrate our towns in the great state of New Hampshire and ensure that good times, good food, and good company are the only things being reported in the news!

When driving to your town’s Old Home Day, be aware of the increased number of pedestrians in the area. Slow down and observe traffic signals and crossing guards.

When walking, cross the street only with a crossing guard, or at an intersection with a walk signal. If these are not available, walk at a crosswalk looking both ways: Left-Right-Left, then make eye contact with drivers as you cross.

Put your phone down when walking (and driving) and be aware of
your surroundings (situational awareness).

Be mindful of choking hazards when collecting small giveaways from parades or booths.

Use sunscreen and wear a hat. Parade routes are not typically in the shade.

If you are attending celebrations at night, wear light colored clothing and or reflective gear. Carry a flashlight and use insect repellent for mosquitos. Give your children glow sticks to use at night – they are a fun way to make your child more visible. (You may find a good deal on glow sticks at a dollar store near you!)

Drink plenty of water to stay hydrated and healthy.

Carrying a little bottle of hand sanitizer or disinfectant wipes is always a good idea to keep your hands clean, especially before eating some of that delicious homemade fair food!

Old Home Day is also a great place for children to practice being independent, but only when parents feel that they are ready. Before heading over to the festivities remind children of the above safety tips and review the additional tips below:

Phone Down-Heads up! Never walk while looking at your phone! Take your headphones out to hear the sounds of traffic.

Stay in the celebration areas. Don’t wander away.

Do not dart into the street or cross between parked cars.

Walk on sidewalks or paths. If there are none, then walk facing traffic and as far to the left as possible.

In our first post of this series, a broad overview of services available as you consider positive change was presented. It included counseling services: individual and group (aimed at readiness preparation and behavior change considerations). Groups were discussed including 12 step programs, as they are excellent to consider in conjunction with each counseling type and provide the peer-to-peer opportunity not found in a one on one setting.

Outpatient care is often a next step in treatment. Whatever path you choose, high quality outpatient support can make a huge difference in your journey.

Outpatient programs can vary from organization to organization depending on the intensity of the program. There is no hospital or facility stay. This is good for people with strong social supports already in place like close family or friends who support the desire to change and can have a positive influence on the process. In addition, it is sometimes helpful to have a member of your support network travel with you to appointments (when needed) or just be available to listen and be a sounding board for you before and after sessions. Outpatient care is less expensive than residential programs. Such programs are often able to address and treat co-occurring mental health disorders as well as the substance misuse issue. Many outpatient models use group counseling in their models as a part of the service menu.

Outpatient programs are the most popular type of treatment available in this region. There is Hampstead Hospital in Hampstead, Granite Recovery Center in Salem, Addiction Recovery Services in Salem, and Crossroads Recovery in Salem just to name a few. There is also Aware Recovery that is a statewide, in home recovery service. They are based in Bedford but they have a team that travels to different locations.

One size does not fit all, so take the time to speak with people at several facilities to see if you feel a connection at a particular program. Below are the links to the services mentioned above:

Understanding your options for regaining your health and sobriety and be very stressful. It is hard to digest the vast amounts of information available to you.

Descriptions of treatment types can be confusing. One size does not fit all and the language of recovery may not always make sense to you. In this series of posts, we will discuss each type of service you might access if you are contemplating change or at a minimum are thinking about speaking with a professional about making a change.

Today we are introducing some first steps you might take when working towards change:

Individual Counseling: A personal meeting with a professional who will speak with you about more than your use of substances. He or she will have a conversation with you about your living situation, strong or faltering relationships with family and friends, employment, legal history and your goals.

Pursuit of Behavior Change: There are resources in the community to take advantage of if you are interesting in examining the path the led you to this place and looking at ways to change your patterns of behavior to support your desire to be substance free. There are experienced professionals ready to help through the following organizations:

12 Step Programs: Alcoholics Anonymous or Narcotics Anonymous are great services and they are present in almost every town in the state. For some, peer-to-peer support is critical in recovery. Sometimes alone or in combination with individual or group counseling 12 Step Programs play a critical and readily available supportive role in recovery. Some locations are:

Lyme Disease Awareness Month may not be a reason to celebrate but it is a reason to take action! Lyme disease is a bacterial infection that is transmitted through the bite of an infected blacklegged tick. New Hampshire has one of the highest rates of Lyme disease in the nation. The best way to prevent getting Lyme disease is to take actions to avoid being bitten by a tick.

Prevention:

Avoid wooded areas with a lot of brush and leaf litter. Stay in the center of a path when possible.

Wear light colored clothing that will show ticks on you, preferably long sleeves, pants, and hat.

Treat your clothes with permethrin (a non-staining insecticide used to repel and kill insects on clothing).

Check yourself and your pet for ticks after being outdoors.

Shower immediately after coming indoors and check ALL your body areas for ticks.

Tick Free NH developed this Shower Card to remind you to do a tick check every day. Tick Free NH is an initiative in New Hampshire that promotes tick awareness and provides information on preventing tick encounters. Go to their website at https://tickfreenh.org/to learn more about tick prevention, protection, and removal of ticks that can cause Lyme disease. You can also find educational materials for you to use and share with others.

there are several tick removal devices available on the market, but a plain set of fine-tipped tweezers will remove a tick effectively.

How to remove a tick:

Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.

Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.

After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

Signs and Symptoms

Ticks can attach to any part of your body but are often found in hard-to-see areas such as the groin, armpits, and scalp. In most cases, the tick must be attached for 36 to 48 hours or longer before Lyme disease can be transmitted. The CDC lists the following early signs and symptoms that can occur 3 to 30 days after a tick bite: (https://www.cdc.gov/lyme/signs_symptoms)

Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)

Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across

May feel warm to the touch but is rarely itchy or painful

Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance

May appear on any area of the body

It is very important to take precautions to avoid tick bites and take immediate action if you are bitten. By taking antibiotics for a few weeks, most people in the early stages of Lyme disease can be treated and will recover completely! (https://www.cdc.gov/lyme/treatment/index.html)If left untreated, the infection can spread to joints, the heart, and the nervous system, so contact your healthcare provider if you have any concerns about a tick bite. Did you know that Lyme disease can also affect your pets? Check your pets often for ticks to ensure that they stay healthy and that they are the only creatures that you are snuggling!

Earth Day is a global event occurring on April 22 of each year. With more than one billion people from 192 countries getting involved, Earth Day is the largest civic-focused day of action in the world (https://www.earthday.org/earthday). The Earth Day Network announced that the focus for Earth Day 2018 will be to End Plastic Pollution.

For many years, we have enjoyed the convenience of using plastics, but may not have been aware of the dangers to the ecosystem and our health. Air pollution, land pollution, and water pollution all impact the ecosystem and can directly and indirectly affect our health. Burning plastic releases chemicals into the air, causing air pollution and affecting the air we breathe. Breathing in too much of this polluted air can cause respiratory ailments. When plastics are dumped into landfills, they not only take up space, but degrade, which also releases chemicals. These chemicals seep into the soil, affecting the soil’s ability to sustain plant life and produce food. These chemicals can also flow into the groundwater, tainting the water that we drink.

Many of us have been to the beach and have seen another form of water pollution. Those random items you see in the sand or floating in the ocean impact the ecosystem. Plastics in the water can harm sea life by entangling them, choking them, or causing other health problems after ingesting. The sea life that consumes these plastics could be the one on your dinner plate. Now those plastic items you see bobbing up and down in the water may not look so innocent. They could be affecting your food, drinking water, and your health.

Garrett Simonsen, South Central NH Medical Reserve Corps Volunteer is dedicated to keeping the beach in his community clean. These are just some of the items he found while doing his part to remove plastics from our oceans.

How big is your Plastic Footprint? A Plastic Footprint is a way of measuring how much plastic you contribute to the worldwide trash pile. Reducing your plastic footprint benefits the ecosystem and decreases health risks for you, your family, and community. The Earth Day Network recommends taking five actions to reduce your plastic pollution footprint: Reduce, Refuse, Reuse, Recycle, and Remove!

REDUCE: Limit your use of plastics! Instead of buying bottled water, try a water filtering system. If you forgot to bring your reusable bags to the grocery store, ask for paper bags and try to buy in bulk. Consider bringing your own clean thermos to the coffee shop for that caffeine fix.

REFUSE: Go without a drinking straw when dining out (you could bring your own paper or reusable straw). Refuse the plastic bag from retail stores – bring your own or consolidate when making many purchases at the mall.

REUSE: Purchase items that can be used multiple times. Consider purchasing a reusable water bottle, thermos, canvas shopping bags, and glass food-storage containers.

RECYCLE: Place recycled items in a recycle bin and not the trash – if bins are not available, consider holding on to recyclable item until you find a bin. Follow your town’s rules on curbside recycling. Encourage your workplace to recycle.

Parkland Medical Center was awarded the Partner Recognition Award in Environmental Excellence from Practice Greenhealth. Parkland diverts 32% of total waste to recycling and promotes green practices throughout the hospital.

REMOVE: Keep your community clean! Join others in your area to remove litter from parks, beaches, schoolyards, and along the sides of roads when safe to do so! (Use gloves and pay attention to dangerous objects.)

By taking small steps today, you can reduce the size of your Plastic Footprint tomorrow!